Toads

Ascribing benefits to the experience of devastating illness or trauma is fraught with hidden dangers.

By Richard P. Sloan | August 1, 2011

John Collier's "In the Forest of Arden"ARTMAGICK.COM

In his book It’s Not About the Bike, Lance Armstrong wrote, “. . .cancer was the best thing that ever happened to me.” However extreme that claim may seem, it expresses the substance of a biomedical research agenda referred to as “benefit finding” or “posttraumatic growth,” whose aim is not only to document such changes but to determine whether they have desirable psychological and medical effects. Indeed, many people report that after confronting serious illness, they discover strengths formerly unrecognized or come to appreciate aspects of their lives they previously did not relish. Whether there are measurably favorable psychological or medical effects of these changes remains to be determined.

However, in addition to these explicit aims, there is considerable surplus meaning to the idea of benefit finding that has not yet been identified, let alone examined. Two candidates immediately come to mind: (1) The implication that the benefits that follow traumatic events are so valuable that they would not be exchanged for a return to the pre-adversity state even if that were possible; (2) The idea that there is something unique about the experience of adversity caused by traumatic events.

Casting an illness as a special opportunity for growth trivializes the adversity.

The language used by researchers Sears, Stanton, and Danoff-Burg—that early stage breast cancer can lead to the “Emerald City of posttraumatic growth”—makes the first point abundantly clear (Health Psychology, 22:487-97, 2003). Emerald City represents an interesting choice of metaphor, suggesting an idyllic location full of possibilities unrealized in one’s current life and made available only by the experience of trauma.

In As You Like It, Shakespeare used a similar trope.

Sweet are the uses of adversity,
Which, like the toad, ugly and venomous,
Wears yet a jewel in his head;
And this our life exempt from public haunt,
Finds tongues in trees, books in the running brooks,
Sermons in stones and good in every thing.

Having been exiled from a civilization characterized by duplicity, deception, and lust for power, the Duke and his followers find their way to the Forest of Arden, where they discover the virtues of living the pastoral life in harmony with nature. Unlike the visitors to the Emerald City of wisdom won through disease, however, all but one of Shakespeare’s exiled characters choose to return to the civilization they revile. Perhaps this is because they have come to realize that despite the jewel worn by the toad, he’s still a toad. Unlike Lance Armstrong, they evidently do not really think that their adversity is the best thing that ever happened to them, because they eagerly embrace the opportunity to restore themselves to their previous condition. Alas, patients with cancer and other serious illnesses do not have that luxury, but there is little doubt that if they did, most of them would happily forego the experience of disease.

Second, the literature on benefit finding and posttraumatic growth suggests there is something unusual and ennobling about illness that permits, even promotes, personal development in a way that is unique. The Emerald City attained through disease connotes something special, and a journey to this place will produce an outcome different from all other experiences. But in fact, experiences of a wide variety have proven to produce profound effects. We learn from our experiences all the time and learn more from intense than trivial ones. Viewing great works of art may provoke life-altering insights. Visitors to the Grand Canyon routinely report feeling humbled in a way that changes them significantly. The birth of a child, the death of a parent, reliably touches and changes us. Casting an illness or other trauma as a special opportunity for growth trivializes the adversity, and that has two unfortunate consequences—one for us as observers and one for those who have been traumatized. For observers, it raises the risk of becoming insensitive to suffering. After all, isn’t disease an opportunity, even a gift? For patients, it imposes a tremendous pressure to capitalize on this opportunity, to be happy about it, or to feel like failures when they are not.

Illness is not a special blessing. It’s not a visit to an Emerald City. It’s just a toad.

Richard P. Sloan is Nathaniel Wharton Professor of Behavioral Medicine at Columbia University Medical Center. He is the author of Blind Faith: The Unholy Alliance of Religion and Medicine, published in 2006 by St. Martin's Press. In a March 2011 Perspective in The Lancet he discussed the persistent belief that individuals control their medical fates.

"That which does not kill you makes you stronger.""When you look into the abyss, the abyss also looks into you." Â Â - Nietzsche

These things are true, and for almost everyone, inevitable. Very few people live and die without suffering. Suffering, pain, transformation, degeneration, regeneration and regrowth in waves until death will happen to everyone. For some, the rediscovery of life that follows a brush with death is a great event. For everyone who recovers, for any length of time, this rediscovery and regrowth can be a great thing although it is not so for all.

To implicitly suggest the mendacity of people finding very real benefits even if they would not have chosen the course, is, in its way, as specious as suggesting that children must like everything that transforms them into better adults. Children don't like it, nor do adults like it. But the reality of the benefit is there.

Mr. Sloan does not like the abyss, that much is clear. He thinks it is not for him and has penned a paean to his discomfort. He is so uncomfortable, in fact, that he wishes to deny what others have found after being dipped into it. But Mr. Sloan will have to face that abyss, sooner or later. We all do.

I assume that Sears, Stanton, and Danoff-Burg base their metaphor of the Emerald City on the 1939 film of the Wizard of Oz and not on the book by L. Frank Baum. Baum's Emerald City was a place of deception and delusion (whimsically so, rather than maliciously), and certainly not a place of true enlightenment.

It is up to the sufferer to judge whether suffering has a benefit, not to the observer. If I believe that what does not kill me makes me stronger, I am fortunate or deluded. If I believe that what does not kill you makes you stronger, I am heartless and cruel.

Im still waiting the personal benefits after my loved onesÂ passed away. When they died I fell in deep distress,Â handicapped by suffering.Â Â People came to me with ridiculous uplifting "winner" experiences that were unintentionally offensive and made me feel worse.I think that all the babbling about the advantages of suffering are just because people survived that moment and are not able to recover former personal references and values, the remaining life will look like a "profit of survival".

"That which does not kill you makes you stronger.""When you look into the abyss, the abyss also looks into you." Â Â - Nietzsche

These things are true, and for almost everyone, inevitable. Very few people live and die without suffering. Suffering, pain, transformation, degeneration, regeneration and regrowth in waves until death will happen to everyone. For some, the rediscovery of life that follows a brush with death is a great event. For everyone who recovers, for any length of time, this rediscovery and regrowth can be a great thing although it is not so for all.

To implicitly suggest the mendacity of people finding very real benefits even if they would not have chosen the course, is, in its way, as specious as suggesting that children must like everything that transforms them into better adults. Children don't like it, nor do adults like it. But the reality of the benefit is there.

Mr. Sloan does not like the abyss, that much is clear. He thinks it is not for him and has penned a paean to his discomfort. He is so uncomfortable, in fact, that he wishes to deny what others have found after being dipped into it. But Mr. Sloan will have to face that abyss, sooner or later. We all do.

I assume that Sears, Stanton, and Danoff-Burg base their metaphor of the Emerald City on the 1939 film of the Wizard of Oz and not on the book by L. Frank Baum. Baum's Emerald City was a place of deception and delusion (whimsically so, rather than maliciously), and certainly not a place of true enlightenment.

It is up to the sufferer to judge whether suffering has a benefit, not to the observer. If I believe that what does not kill me makes me stronger, I am fortunate or deluded. If I believe that what does not kill you makes you stronger, I am heartless and cruel.

Im still waiting the personal benefits after my loved onesÂ passed away. When they died I fell in deep distress,Â handicapped by suffering.Â Â People came to me with ridiculous uplifting "winner" experiences that were unintentionally offensive and made me feel worse.I think that all the babbling about the advantages of suffering are just because people survived that moment and are not able to recover former personal references and values, the remaining life will look like a "profit of survival".

"That which does not kill you makes you stronger.""When you look into the abyss, the abyss also looks into you." Â Â - Nietzsche

These things are true, and for almost everyone, inevitable. Very few people live and die without suffering. Suffering, pain, transformation, degeneration, regeneration and regrowth in waves until death will happen to everyone. For some, the rediscovery of life that follows a brush with death is a great event. For everyone who recovers, for any length of time, this rediscovery and regrowth can be a great thing although it is not so for all.

To implicitly suggest the mendacity of people finding very real benefits even if they would not have chosen the course, is, in its way, as specious as suggesting that children must like everything that transforms them into better adults. Children don't like it, nor do adults like it. But the reality of the benefit is there.

Mr. Sloan does not like the abyss, that much is clear. He thinks it is not for him and has penned a paean to his discomfort. He is so uncomfortable, in fact, that he wishes to deny what others have found after being dipped into it. But Mr. Sloan will have to face that abyss, sooner or later. We all do.

I assume that Sears, Stanton, and Danoff-Burg base their metaphor of the Emerald City on the 1939 film of the Wizard of Oz and not on the book by L. Frank Baum. Baum's Emerald City was a place of deception and delusion (whimsically so, rather than maliciously), and certainly not a place of true enlightenment.

It is up to the sufferer to judge whether suffering has a benefit, not to the observer. If I believe that what does not kill me makes me stronger, I am fortunate or deluded. If I believe that what does not kill you makes you stronger, I am heartless and cruel.

Im still waiting the personal benefits after my loved onesÂ passed away. When they died I fell in deep distress,Â handicapped by suffering.Â Â People came to me with ridiculous uplifting "winner" experiences that were unintentionally offensive and made me feel worse.I think that all the babbling about the advantages of suffering are just because people survived that moment and are not able to recover former personal references and values, the remaining life will look like a "profit of survival".

So many problems with the logic in this article, not sure where to start.Â I`ll point out a couple and move on.Â One is the idea that because some people (e.g. the Duke and his followers) did not go through dramatic transformations from their experiences no one else does or will.Â Another is that being exiled/ shamed/ shunned, which is largely as social experience, is similar to confronting a potentially terminal illness, which is often an existential experience.Â One last problem of logic.Â Why is it `Casting an illness or other trauma as a special opportunity for growth trivializes the adversity`?Â Can`t an illness be both an adversity AND an opportunity for growth?Â One does not have to trivialize the other.Â Â

More to the central point of the article: I work with clients who come in with stress induced/ augmented physical conditions, the causal psychosocial components of which are finally addressed and resolved in therapy, leading to significant growth and increases in quality of life.Â Â The illness was both adverse and eventually led to large psychosocial benefits for them and their families.Â Most go through a stage where they cry about how they wish they had addressed the psychosocial imbalances earlier in their life, before they affected them physically.Â Unfortunately many people do not to take some opportunities for growth until they have exhausted all options of avoidance.Â Thus we create the scenario where â€œ. . . cancer was the best thing that ever happened to me.â€쳌Â Ask Lance, I suspect he`ll tell you in retrospect that he can see where he avoided learning these life lessons earlier in his life.

The last paragraph expresses my thoughts exactly. But assuming that some sufferers might find a benefit, do they ever find such benefits due to the suggestions of others? If so, isn't it conceivable that an observer (possibly one with similar experiences) might be able to suggest how to find strength from the suffering?

So many problems with the logic in this article, not sure where to start.Â I`ll point out a couple and move on.Â One is the idea that because some people (e.g. the Duke and his followers) did not go through dramatic transformations from their experiences no one else does or will.Â Another is that being exiled/ shamed/ shunned, which is largely as social experience, is similar to confronting a potentially terminal illness, which is often an existential experience.Â One last problem of logic.Â Why is it `Casting an illness or other trauma as a special opportunity for growth trivializes the adversity`?Â Can`t an illness be both an adversity AND an opportunity for growth?Â One does not have to trivialize the other.Â Â

More to the central point of the article: I work with clients who come in with stress induced/ augmented physical conditions, the causal psychosocial components of which are finally addressed and resolved in therapy, leading to significant growth and increases in quality of life.Â Â The illness was both adverse and eventually led to large psychosocial benefits for them and their families.Â Most go through a stage where they cry about how they wish they had addressed the psychosocial imbalances earlier in their life, before they affected them physically.Â Unfortunately many people do not to take some opportunities for growth until they have exhausted all options of avoidance.Â Thus we create the scenario where â€œ. . . cancer was the best thing that ever happened to me.â€쳌Â Ask Lance, I suspect he`ll tell you in retrospect that he can see where he avoided learning these life lessons earlier in his life.

The last paragraph expresses my thoughts exactly. But assuming that some sufferers might find a benefit, do they ever find such benefits due to the suggestions of others? If so, isn't it conceivable that an observer (possibly one with similar experiences) might be able to suggest how to find strength from the suffering?

So many problems with the logic in this article, not sure where to start.Â I`ll point out a couple and move on.Â One is the idea that because some people (e.g. the Duke and his followers) did not go through dramatic transformations from their experiences no one else does or will.Â Another is that being exiled/ shamed/ shunned, which is largely as social experience, is similar to confronting a potentially terminal illness, which is often an existential experience.Â One last problem of logic.Â Why is it `Casting an illness or other trauma as a special opportunity for growth trivializes the adversity`?Â Can`t an illness be both an adversity AND an opportunity for growth?Â One does not have to trivialize the other.Â Â

More to the central point of the article: I work with clients who come in with stress induced/ augmented physical conditions, the causal psychosocial components of which are finally addressed and resolved in therapy, leading to significant growth and increases in quality of life.Â Â The illness was both adverse and eventually led to large psychosocial benefits for them and their families.Â Most go through a stage where they cry about how they wish they had addressed the psychosocial imbalances earlier in their life, before they affected them physically.Â Unfortunately many people do not to take some opportunities for growth until they have exhausted all options of avoidance.Â Thus we create the scenario where â€œ. . . cancer was the best thing that ever happened to me.â€쳌Â Ask Lance, I suspect he`ll tell you in retrospect that he can see where he avoided learning these life lessons earlier in his life.

The last paragraph expresses my thoughts exactly. But assuming that some sufferers might find a benefit, do they ever find such benefits due to the suggestions of others? If so, isn't it conceivable that an observer (possibly one with similar experiences) might be able to suggest how to find strength from the suffering?

Professor Slone is incorrect in suggesting that the literature on posttraumatic growth insists or assumes there is something unusual or ennobling about illness. Crises are common and none who argue posttraumatic benefit assume it is enobling. Rather, the argument is that fundamental crises, illness or others, force a reordering of priorities and a reformulation of world view.Â Â In my studies of caregivers for fragile seniors I found many for whom this was true (1) and, too, in my studies of persons who live with life altering diseases (MS) (2)Â or conditions (spinal chord injury) find new meanings in life, new ways of being, and perceptions of what is important.Â Â Â Tom Koch, PhD

Professor Slone is incorrect in suggesting that the literature on posttraumatic growth insists or assumes there is something unusual or ennobling about illness. Crises are common and none who argue posttraumatic benefit assume it is enobling. Rather, the argument is that fundamental crises, illness or others, force a reordering of priorities and a reformulation of world view.Â Â In my studies of caregivers for fragile seniors I found many for whom this was true (1) and, too, in my studies of persons who live with life altering diseases (MS) (2)Â or conditions (spinal chord injury) find new meanings in life, new ways of being, and perceptions of what is important.Â Â Â Tom Koch, PhD

Professor Slone is incorrect in suggesting that the literature on posttraumatic growth insists or assumes there is something unusual or ennobling about illness. Crises are common and none who argue posttraumatic benefit assume it is enobling. Rather, the argument is that fundamental crises, illness or others, force a reordering of priorities and a reformulation of world view.Â Â In my studies of caregivers for fragile seniors I found many for whom this was true (1) and, too, in my studies of persons who live with life altering diseases (MS) (2)Â or conditions (spinal chord injury) find new meanings in life, new ways of being, and perceptions of what is important.Â Â Â Tom Koch, PhD